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24
This peculiar distribution of the cases clearly points to direct
infection from person to person, as being the most probable cause of
infection. Had infection spread by means of the atmosphere,
water or milk supplies, the distribution of cases must have been more
general throughout the district. Enquiries into the origin of
infection in the various cases and groups of cases, have almost
invariably pointed to contact, directly or indirectly, as the most
probable means by which the disease spread. This contact between
infected and non-infected children taking place in school, in play
grounds, in the streets, and also from house to house, as will be
illustrated in the summaries of cases given below. It is generally
recognised that personal infection is the chief meams by which
Scarlet Fever spreads; such being the case, it is clear that if we
knew of all cases of Scarlet Fever as they occurred, by isolating all
those attacked and thoroughly disinfecting the surroundings occupied
by the patient a centre for infection ceases to exist, and whenever
the disease appeared, it should be a comparatively easy matter to
limit its spread, and eventually stamp it out.
The provisions of the Infectious Diseases Notification Act are
framed with this object in view, but as I have previously pointed out,
'Notified' Scarlet Fever is by no means an index of the prevalence of
the disease, since cases are often so mild in character, and the
symptons of such an anomalous nature, that it cannot be always
recognised even by doctors, until peeling of the hands and feet takes
place; which sometimes does not commence until 3 or 4 weeks after
the first days of the illness.
It is only to be expected therefore that parents overlook the
nature of these slight cases. It is the occurrence of these overlooked
cases which explains the apparent inadequacy of isolation in preventing
the spread of the disease, and the impossibility of tracing the
sequence of persons through which infection has passed, from one
notified case to another. How numerous these 'overlooked' cases
have been, will be apparent from the following brief summary of the
groups of cases.
(1) No case of Scarlet Fever was notified in the district from
December 8th, 1903, to February 9th, 1904, from which date to
March 13th, twelve certificates were received.
Eleven of these cases occurred in houses on the South side of
the district, Steamfield Estate, Dudley Road, Gladstone Road,
Queen's Road and Clarence Street, and one on the North side. There
seemed little doubt that in the first five of these cases notified between
February 9th and 19th, that the Featherstone Road Infants and
Featherstone Road Boys' Schools were concerned, and light was
thrown on this, as one of the scholars was subsequently found in
school in the peeling stage of the disease, which from appearances
and history, was of about a month's duration.